Oxytocin Infusion versus Vaginal Misoprostol in Reducing Blood Loss during Abdominal Myomectomy: A Randomized Controlled Trial

Abstract

Uterine fibroids (leiomyomas) are benign uterine masses with a prevalence of up to 20% to 50% in reproductive-aged women. They may cause heavy menstrual bleeding, bulk symptoms, or decreased fertility, and surgical removal (myomectomy) is commonly offered to women who wish to maintain future fertility. Although laparoscopic and robotic techniques are increasingly common, laparotomy may be required depending on the location, number, and size of fibroids as well as individual surgeon preference. Open myomectomy is often required for large or multiple fibroids and is associated with increased perioperative blood loss and a transfusion rate of up to 20%. The impact of excessive blood loss can range from anemia and blood transfusion, to hysterectomy, prolonged hospital stays and potentially death. Blood transfusion carries significant risks to patients, including acute transfusion reactions and potential development of red blood cell (RBC) antibodies through alloimmunization. Therefore, different management strategies have been proposed over the past decades to reduce the risk of perioperative hemorrhage. These interventions include the application of a tourniquet to mechanically stop bleeding, preoperative gonadotrophin-releasing hormone (GnRH) analogs to reduce the uterine volume and fibroid size, uterine artery dissection or embolization, and perioperative pharmacological interventions In recent years, a growing body of literature has investigated the efficacy of various perioperative pharmacological interventions to reduce blood loss during myomectomy. Uterotonic medications such as oxytocin and misoprostol can represent useful therapeutics in reducing blood loss through their reduction of uterine artery blood flow. Misoprostol, a prostaglandin E1 analogue, acts as a uterotonic and vasoconstrictor and is commonly used in the management of postpartum hemorrhage. The use of misoprostol in the non-gravid uterus has been established with evidence of uterine contractility. In addition, synthetic oxytocin analogues are used in the treatment of postpartum uterine atony and bleeding. Oxytocin receptors are also present in the nonpregnant uterus. In the last few years, synthetic oxytocin analogues have been introduced in gynecologic procedures including hysterectomies, myomectomies and endometrial resections to decrease bleeding. The study aim was to compare between the efficacy of intraoperative oxytocin infusion and preoperative vaginal misoprostol in reducing blood loss during abdominal myomectomies. This prospective randomized controlled trial was conducted at tertiary care hospital at Ain Shams University hospitals from July 2017 till May 2021.